.

Application ID: AS/0910/_________

V> h
School Admission Form
Simandhar City, Tri-mandir, Ahmedabad-Kalol Highway, Adalaj, Dist: Gandhinagar -382 421
2009-10 Academic Year 2009-10

/Application Date:_____/_____/_______
za_ /Name of the Child : ________________________________________________________________
/First Name
_ /Father's Name
/Surname
H /Class Applied For : _________________________________________________________________
/Gender: _____________ (M/F) /Religion: _____________________ i/Cast: ___________________
L /Date of Birth: _____/______/_________ L V/ Place of Birth: ____________________________
/Category: _______________ ( Open/BC/OBC/ST) W/Nationality: _________________________
I/Mother Tongue: ____________ H ?/Languages spoken: _______________________
_/Address: _____________________________________________________________________________
/City: _________________________________ F/State: ______________________________________
S/District _____________________/Country: _______________________/Pin: __________________
V>_ ? Previous School Name: ______________________________________________________
_/Address: _____________________________________________________________________________
_ /Previous Board: __________________ _ K/Previous Medium: ______________________
_ H/Previous Std.: ____________________________________________________________________
_ H/Reason for Leaving Previous School: _______________________________________
_ /Current Board: GSEB _____ K/Current Medium: GUJARATI _______

_/

Subject

Maths

English

Science

Social Science

Gujarati

H (100_)
Marks (out of 100)

H (100_)
Marks (out of 100)

_V

QM

..

Sanskrit

Hindi

Computer

P.T.

Art

/Percentage : ___________(%) /Grade: _____________ Z /Exam Date : ____/____/________

_ /Fathers Name: _________________________________________________________________

/First Name

_ /Father's Name

/Surname

L /Birth Date: ____/____/________

_ H/Fathers Qualification: _________________T/Occupation: _____________________
/Annual Income: ___________________________________________________________________
_ /_ Office Address: __________________________________________________________________
__________________________________________________________________________________________
/City: _________________________________ F/State: _____________________________________
S/Dirtrict _____________________/Country: _______________________/Pin: __________________

_./Tel.No.: _________________________ _./(M): _________________________________________

-/Email: _______________________________________________________________________________
_ /Mothers Name: ________________________________________________________________
/First Name /_ /Husband/Father's Name /Surname
L /Birth Date: ____/____/________
_ H/Mothers Qualification: _________________T/Occupation: ___________________
/Annual Income: ___________________________________________________________________
_ /_ Office Address: __________________________________________________________________
__________________________________________________________________________________________
/City: _________________________________ F/State: _____________________________________
S/Dirtrict _____________________/Country: _______________________/Pin: __________________

_./Tel.No.: _________________________ _./(M): _________________________________________

-/Email: _______________________________________________________________________________
za - ?...(/) Does the child have any Sibling(s)? _________ (Yes/No)
1) -_ /Name of the Sibling: ___________________________________________________________
/First Name

_ /Father's Name

/Surname

__/Relation : __________________________________________ L /Birth Date: ____/____/________

V>_ /School Name: _______________________________________________________________________
@/Class: ________________ /Board: _____________________ K/Medium:_____________________
2) -_ /Name of the Sibling: ___________________________________________________________
/First Name

_ /Father's Name

/Surname

__/Relation : __________________________________________ L /Birth Date: ____/____/________

V>_ /School Name: _______________________________________________________________________
@/Class: ________________ /Board: _____________________ K/Medium:_____________________
<<_ /Family Background: _____________________________________(<<_/@)/ (Joint/Nucleus)

za ( )/Childs Medical History (Allergies, if any): ___________________

/Medications : ___________________________________________________________________
L _ / In Case of Emergency Alternate Contact :
1./Name_____________________________________ 2./Name_________________________________
1. _./ Phone No.______________________________ 2. _./ Phone No.___________________________

O ()(B, L V, Tk, TI)/Write a few words

about your child (Optional): (Aptitude/Temperament/Hobbies/Personality)
____________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________

V>_ ?/ Why do you want to send your child to this school ?

_______________________________________________________________________________________________

Tk_ w ? /In what way could you be helpful to the school activities?
____________________________________________________________________________________________________________________________________________________________________________________

H/Reference of Dada Bhagwan Parivar: ______________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

H @L {Z ./* List of Attested Documents enclosed herewith (Photocopy):

1.L Hh/Birth Certificate

2. /Previous years mark sheets

3. Hh/Leaving Certificate

4. H /Residence Proof

5. /Parents Photos

6. _ { /Five Passport Size Photographs

_ yH H_ \_ H B . _V
_ _ o _ \_ H _ _ o
_ \_./I hereby confirm that the above mentioned details are correct to my knowledge. I confirm that my
child will follow all the schools & organizations rules & regulations and I am bound to complete settlements for
any damages caused.

/Date

/Mothers Signature /Fathers Signature /Guardians Signature

VH/ZH [@ V> ] /COMMENTS/OBSERVATIONS [FOR SCHOOL USE ONLY] :

/SIGNATURE:

Simandhar City, Tri-mandir, Ahmedabad-Kalol Highway, Adalaj, Dist: Gandhinagar -382 421
Contact: +91 79 39830888, email:[email protected], www.ase-simc.com